Hematopoeisis
What is a hemoglobin molecule made up of?
What is the normal type of hemoglobin in an adult?
Newborn?
What morphological characteristic is found on peripheral smears of patients with CLL?
What other characteristics are found in CLL?
Smudge cells
Small, hyperclumped lymphs
What is the formula for MCV, MCH, MCHC?
What is another name for these terms?
What is the formula for NRBC?
MCV= HCTx10/RBC, MCH= HGBx10/RBC, MCHC= HGB x100/HCT
Indices
(Total WBC count x 100) / (100+ #NRBC per 100WBC)
What are some nonmalignant lymphocytosis conditions? What cells are seen?
What are the causes of each one?
How do we tell them apart?
IM: variant lymphs, EBV, heterophil antibody
CMV: variant lymphs, herpes family, neg heterophil
Toxoplasmosis: toxoplasma gondii, resemble mono, test for TG antibodies
What type of anticoagulant is used when drawing specimens for coagulation?
What is a normal PT? aPTT?
Sodium citrate- blue
PT: 10-20 seconds
aPTT: under 30 sec
What is EPO?
What produces EPO?
What does it do?
Erythropotietin
Kidney
stimulates the production of RBC when oxygen is low
Name some plasma cell diseases.
What are some characteristics of each?
Multiple myeloma, Waldenstroms Macroglobulinemia
MM- increased IgG or IgA (M Spike), bone involvement, rouleux, BJ proteins, CRAB, increased ESR
WM- IgM no bone involvement, cryoglobulins, slightly increased ESR, plasmacytoid lymphs
What are these inclusions made up of?
Howell Jolly bodies
Heinz bodies
Pappenheimer Bodies
Basophilic Stippling
HJB-DNA
HB-Hemoglobin
Pap- Iron Deposits
BS- Ribosomes
Case study: Calculate indices and determine what type of anemia is seen (2 options)
WBC 4.0
RBC 3.5
Platelet: 100
HGB: 10.0
HCT: 32.0
Retic: 4.0%
Normal Iron studies
Normo/normo anemia
increased retics
Blood loss or hemolytic anemia
Which factors are Vitamin K dependent?
What group do these belong to?
What drug interferes with these?
II, VII, IX, X
prothrombin
warfarin (coumadin)
What is the correct order of RBC maturation?
Reticulocytes can be seen easier using which kind of stain?
What cells contain auer rods?
What categories of AML could have auer rods?
Myeloblasts
M0, M1, M2
If the MCV is 70, what types of anemia is the physician thinking?
How do we distinguish what kind?
IDA, SA, ACD, Thalassemia
Iron studies, genetic testing for Thalassemia
What is the most common anemia?
What other type of anemia can lead to this type? Explain how.
How do we differentiate it from other type of anemia's in this category?
What morphological features would this type of anemia have?
IDA
Chronic blood loss- slow blood loss, slowly decrease iron = IDA
iron studies
micro/hypo, ovals, targets
What factor breaks down the fibrin clot?
What lab assay can be done to determine if this is happening?
plasmin
DDimer
What is the order of the myeloid line of WBC's?
What cells are included in the myeloid cell line?
Myeloblast, promyelocyte, myelocyte, metamyelocyte, band, segmented
Neutrophils, basophils, eosinophils
What AML has many coarsely granular promyelocytes with dumbbell shaped or bilobed nuclei predominate in?
What AML has blasts of monocytic type that predominate?
AML where myeloid and monocytic acute leukemia’s are classified?
M2
M5
M4
What RBC disease has an MCHC above 36?
What would the MCV be for someone with this condition?
What main category of conditions is the disease above in?
Spherocytosis
Normal
Normo/normo, hemolytic anemia of a membrane defect
WBC 25.0
RBC: 4.0
HGB: 10.0
HCT: 32.0
Seg 55%, band 8%, myelocyte 5%, Promyelocyte 17%, lymph 12%, mono 3%
+SBB, +MPO, +SE
translocation (15:17)
M3
List all factors with their "name".
see chart
What is the earliest granulocytic maturational stage in which primary granules appear is?
What is the earliest granulocytic maturational stage in which secondary granules appear is?
Promyelocyte
Myelocyte
A laboratory assay that can be used to differentiate a leukemoid reaction from chronic myelogenous leukemia is?
A laboratory assay that can differentiate M1 and M6?
LAP
M1- MPO, SBB
M6- PAS, SE, NSE
A patient presents with extremely elevated LD, hypersegmented neutrophils, teardrops, MCV 110 and antibodies to the intrinisic factor (IF). What type of anemia is this classified as?
Macrocytic, Megaloblastic, Vitamin B12 deficiency
Pernicious Anemia
What WBC condition has characteristic teardrops on the peripheral smear?
dry bone tap, slightly increased LD, nRBC, Jak2 mutation
MMM
Write out the intrinsic and extrinsic pathway with where inhibitors act and where laboratory testing is occuring.
see chart